BACKGROUND In-person interviews for surgical training programs have been suspended due to the SARS-CoV-2 (COVID-19) pandemic. 1,2 At The University of Texas, MD Anderson Cancer Center, restrictions prohibiting visits to our institution, including trainee applicant interviews, were announced on March 9, 2020. In-person Complex General Surgical Oncology Fellowship interviews were scheduled for March 13 to 14, 2020 and were immediately converted to a virtual approach for these dates. The aim of this manuscript is to share lessons learned and recommendations for conducting virtual interviews for surgical trainee applicants. PERSONNEL Organizing virtual interviews for surgical trainees requires buy-in from stakeholders in the program. On March 9, a meeting of the Department of Surgical Oncology fellowship program education committee was held to choose between conversion to virtual interviews on the originally scheduled dates or to postpone and conduct in-person interviews at an unknown future date. The group concluded that a virtual approach on the originally confirmed dates was in the best interest of applicants. Essential personnel who coordinate efforts and participate can be broadly categorized as follows: 1. Program administration: Department Chair, Training Program Director (PD) and Associate Directors, Program Coordinator. 2. Interviewers: Faculty, current trainees 3. Information Technology: On-site IT support 4. Support staff: Administrative staff, noninterviewing program faculty 5. Trainee applicants TECHNOLOGY Information Technology (IT) personnel was identified as a necessity for organizing virtual interviews. Selection of a web-based teleconferencing platform was the first step in our planning. We selected WebEx (Cisco, San Jose, CA) as the platform to conduct interviews because of our institutional contract, but there are several other options including, but not limited to, Skype (Microsoft, Redmond WA) and Zoom (Zoom Video Communications, San Jose, CA). For our group activities, we utilized a hybrid approach; the trainee applicants all attended virtually and the PD and current trainees were physically present in a large conference room. If current local rules prevent congregation, group activities can employ a completely virtual approach with all individuals participating remotely. Programs will require platforms for web-based teleconferencing, digital cameras, and digital audio or landline telephones. We utilized a hybrid approach for individual interviews as well; often having 2 interviewers physically in 1 room interacting with the applicant. To facilitate this approach, we used a dedicated desktop computer for each applicant's series of 6 interviews, whereas the interviewers rotated rooms. In a completely virtual approach most web-based teleconferencing applications have an option to utilize a virtual lobby and interviewers and applicants can be designated into private conversations. Contingency planning included obtaining contact information for applicants before initiating interviews so that telephone, FaceTime (Apple, Cupertino, CA), or other smartphone-based teleconferencing could be utilized as a backup. Laptops were on hand to be used as backups in the case of a technical malfunction with a desktop. INFECTION CONTROL When utilizing a conference room for a group activity, it is important to maintain proper social distancing in light of COVID19. 3 Per current guidelines, individuals should remain spaced >6 feet apart and avoid direct physical contact with one another. Utilizing a single office for each applicant allowed for straightforward infection control. The desk, computer keyboard, mouse, and telephone were cleaned in-between each interviewer rotation. Interviewers were reminded of observed proper hand washing or use of hand sanitizer when rotating between applicant interviews. PRE-INTERVIEW COMMUNICATION A schedule of interview activities was provided to each applicant with instructions on how to access each activity using the selected teleconferencing platform. Some applicants had difficulty securing a computer, webcam, internet, and audio capabilities in a private space on short notice, and required the assistance of their current training programs. For previous in-person interviews, we provide a detailed packet of program information upon arrival. Two days in advance of the web-based virtual event, a portable document format (PDF) version was distributed. This document allows for meaningful use of interface time during interviews as questions may be developed before the event. FORMAT Overall, we maintained the general structure of our in-person approach. We truncated virtual activities as we hypothesized that attention spans of training program representatives and applicants are shorter than during in-person interviews. We also feel strongly that interviews should be conducted during a discreet period of time. Scheduling interviews intermittently over weeks creates disturbances for applicants applying to multiple institutions and deters formation of a solidified program impression. Our program's traditional in-person activities the night before interviews include a tour of the campus (45 minutes), a cocktail reception with program faculty and fellows (1 hour), presentations about the program (1 hour), and a dinner with the current fellows (2 hours). For our virtual program, we condensed these group activities into 2 hours. Evening virtual events included an icebreaker (5 minutes), presentation from the PD (10 minutes), and fellow-led presentations on research, professional development, and living in the area (15 minutes each). A prerecorded 5-minute virtual tour of the department and institution by the fellows was also shown for information and comic relief. Additionally, a 1-hour question and answer session between the applicants and the fellows was conducted. These unscripted interactions between the current trainees and applicants have been identified by our program committee as vital to applicant experience. We designated an individual to be the master of ceremonies (MC) in the virtual setting. The MC's responsibilities include appropriate muting of participant microphones, progressing through the designated activities, and calling on individual applicants and representatives of the program to avoid multiple simultaneous speakers. For the question and answer portion of the program, applicants were asked to submit typed questions through WebEx and the MC-selected fellows to respond. This approach facilitates aggregation of similar questions and the development of a question queue to minimize downtime between questions. Our traditional interview scheduling includes in-person interviews conducted with 2 waves of 6 rounds of 12 simultaneous interviews as seen in Figure 1. Each applicant has a separate interview time with the department chair and fellowship PD. This schedule was recreated in a virtual setting. Interviews were 20 minutes with 5-minute breaks in between interviews. FIGURE 1 Interview scheduling template. We had a combination of 1- and 2-interviewer rooms. When technical issues arise, having 2 interviewers allows one individual to summon IT help or troubleshoot directly, whereas the other individual is able to continue the interview, by a temporary alternate mechanism if necessary. Virtual conversations with 2 interviewers also tended to be less stilted. However, having 2 interviewers physically together can present challenges maintaining appropriate social distancing while also ensuring that natural conversation and quality audio visual capture and transmission are occurring. POST-INTERVIEW COMMUNICATION After interview completion, follow-up communication with applicants was initiated, including providing additional information based upon individual interviews. Additionally, we provided each applicant with contact information for a current fellow to serve as a resource for additional questions that may evolve following the interview process. We believe this informal yet direct approach leads to improved communication throughout the interview process and fosters future professional relationships. Both applicants and participants from the program were anonymously surveyed after the interview process. A Likert scale [0 (poor)–10 (excellent)] was used for most responses. The current fellows who participated in the preinterview group activities gave a mean overall rating of 8.33 range (7–10), trainee applicants gave a mean rating of 8.86 (range 6–10). For the interviews, interviewers gave a mean overall experience rating of 8.3 (range 7–9) and applicants gave a mean overall rating of 9.2 (range 6–10). All interviewers, current fellows, and trainee applicants questioned regarding length and number of interviews answered “just right” as opposed to “too long” or “too short.” No applicant preferred virtual interviews to in-person interviews, but several stated they would not have a preference given a choice of either in the future. RECOMMENDATIONS Based on the experience of our virtual interviews, we developed recommendations for programs that are going to implement similar processes in the future. We have divided them chronologically into preinterview, interview and post-interview. They are summarized in Table 1. TABLE 1 Recommendations for Programs Conducting Virtual Interviews CONCLUSIONS The rapid evolution of social distancing in the setting of SARS-CoV-2 has required surgical training programs to adopt virtual interview processes. It is important to involve program stakeholders in the design and implementation process. Careful attention to the challenges and opportunities of virtual interviews, including those in the technology, process flow, interviewer and team safety, communication, interpersonal, and social domains, can result in rapid implementation of a successful virtual interview experience.